tbuckley/cabot-search huggingface dataset:
Clinical Case 11—Acute multivessel coronary artery thrombi: an unusual presentation of STEMI and management dilemma in a young patient with COVID-19
Authors: Emma Higgisson, Carl Vaughan
Journal: Cardiovascular Research (2022)

Abstract Mr DC is a fit and healthy 32-year-old gentleman who presented on day 13 of his mild COVID-19 illness with sudden onset central chest discomfort, diaphoresis and vomiting following exercise. He had no past medical history, no significant cardiovascular risk factors and a normal physical exam. ECG showed ST elevation in anterior and inferior leads. Mr DC underwent coronary angiogram which revealed a large semi-occlusive thrombus in the proximal LAD and moderate thrombus in the proximal RCA. There was no significant stenosis or plaque in any vessel. The diagnosis was therefore STEMI secondary to multivessel proximal coronary artery thrombi. We hypothesise that the patient's concurrent COVID-19 infection, hypercoagulable state post exercise and possible plaque rupture led to the development of these thrombi. This is a very unusual case and presented a management dilemma. We decided to manage him conservatively with therapeutic heparin, dual antiplatelet therapy, bisoprolol and high dose statin therapy. Following one week of conservative management, we performed a repeat coronary angiogram which showed complete resolution of all intracoronary thrombi and yielded an excellent angiographic result. The patient was discharged to complete 1 year of dual antiplatelet therapy and has done very well. Learning points include: risk factors and management options for coronary artery thrombosis, successful conservative management strategy, interval of repeat diagnostic imaging, coronary artery thrombosis associated with COVID-19 infection, the potential for mild clinical COVID-19 illness but significant cardiovascular complications, more research needed on anticoagulation and antiplatelet treatment of ACS in the context of COVID-19.
Clinical Case 17—A catastrophic case of ischemic stroke and acute myocarditis in a young patient following mRNA COVID-19 vaccination: coincidence or consequence?
Authors: Jéni José Sá Quintal, Carina Graça, Dúlio Passos, Tiago Camacho, Gonçalo Faro Silva, Susana Chaves, Nicodemos Fernandes, Tiago Catanho, João Adriano Sousa, Diogo Rijo, Joana Caires, José Júlio Nóbrega
Journal: Cardiovascular Research (2022)

Abstract A healthy 32-years-old man was admitted in emergency department after cardiac arrest at home. He had complaints of fatigue and general malaise after Pfizer-BioNTech Coronavirus disease-2019 (COVID-19) first dose vaccine 48 hours earlier. Upon hospital admission, patient scored 3 points in Glasgow Coma Scale. Electrocardiogram showed atrial fibrillation with rapid ventricular response and a point-of-care ultrasound demonstrated severe left ventricular dysfunction with global hypokinesia. Blood tests were remarkable for elevation of high-sensitivity cardiac troponin-T and inflammatory parameters, normal platelet and fibrinogen levels and slightly increased D-dimer. A computed tomography (CT) with angiography of the cerebral arteries revealed acute ischemic posterior circulation stroke with total occlusion of the basilar artery and partial occlusion of the left vertebral artery. Life-saving systemic thrombolysis was performed but there was no clinical benefit. Pulmonary embolism was excluded. Transesophageal echocardiography showed severe left ventricular dysfunction (LVEF 30%), global hypokinesia and an apical thrombus with no other significant abnormalities. De novo multiple ischemic injuries were shown in 24h control brain CT. Once autoimmunity, thrombophilia study, PCR and serologic tests for viral infections including SARS-CoV-2 were negative, cardioembolic stroke following post-vaccinal myocarditis was suspected. Brain stem death was verified 72h later and a post-mortem endomyocardial biopsy was performed, although no signal of myocarditis was found. COVID-19 mRNA vaccination is associated with increased risk of myocarditis. We report the first known case of cardioembolic stroke and probable myocarditis after BNT162b2 first dose. This highlights that, although rare and with a predominantly favorable course, vaccine-related myocarditis can have life-threatening complications. Figure 1Apical left ventricle thrombus on transesophageal echocardiography.
Poster No. 138 Thromboembolic and bleeding risks due to perioperative stop of antithrombotic treatment in non-cardiac surgery - a single center experience
Authors: Mariana Ferreira Carvalho, Carolina Gonçalves, Margarida Cabral, Sara Lopes Fernandes, Rita Ribeiro Carvalho, Jorge Guardado, Alexandre Antunes, João Morais
Journal: Cardiovascular Research (2022)

Abstract Introduction Discontinuation of antiplatelet therapy is essential for patients in the perioperative period submitted to high bleeding risk non-cardiac surgery (NCS). Similarly, oral anticoagulants should be interrupted before high risk surgical procedures, excluding patients with mechanical heart valves together with any thromboembolic risk factors. Interruption of this medication may increase thromboembolic events, however, their frequency still remains unclear. Purpose We aim to evaluate the thromboembolic and bleeding events due to perioperative cessation of antithrombotic treatment in non-cardiac surgery approach in the population in our center. Methods A single-center retrospective observational analysis between January 2015 and August 2022 evaluated 356 patients. Eligibility criteria included: interruption of antithrombotic or anticoagulant therapy, high cardiovascular risk with previous cardiovascular disease diagnosis, planned major non-cardiac surgery, and perioperative follow-up at our center. Results A total 356 patients undergoing NCS were eligible in the cohort: 91.2% of patients with high bleeding risk surgery and 94.5% with mild-moderate thrombotic risk. All cause death occurred in 4 patients (1.1%), thrombotic events in 4 patients (1.1%) and major bleeding events in 11 patients (3.1%). Hemoglobin level (P = 0.004), duration of surgery (P &amp;lt; 0.001) and age (P = 0.004) were significantly related to the risk of bleeding events. Mean duration of interruption of antithrombotic therapy was of 8 ± 2 days. Conclusions Although cessation of antithrombotic therapy, hemorrhagic events are more associated than thrombotic ones in patients with previous cardiac disease that underwent elective NCS. The factors with significant association with bleeding complications after NCS were age, hemoglobin level, and duration of surgery.
Oral Presentation No. 006 Postoperative Myocardial Injury due to Platelet Reactivity in Patients undergoing Vascular Surgery
Authors: K L Zheng
Journal: Cardiovascular Research (2022)

Abstract Background Postoperative myocardial injury (PMI) after major vascular surgery, detected by elevated cardiac troponin (cTn), has been associated with morbidity and mortality. It is unclear whether the pathophysiology of PMI is determined by increased platelet activity. Objective To examine the relationship between platelet activation (P-selectin expression) and PMI(cTn release as continuum) in patients undergoing elective open abdominal aortic surgery in the early post-operative period. Methods This prospective, single-centre, observational, cohort study included 33 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. Unstimulated platelet activation was measured by platelet bound P-selectin expression (range 0–100%). Explorative coagulation measurements were: stimulated platelet aggregation measured with the VerifyNow® assay (aspirin cartridge), with the Multiplate® analyzer (ASPI, ADP and TRAP) and stimulated coagulation status evaluated by the TEG® Haemostasis Analyzer System (global haemostasis cartridge). The primary outcome was cTn release assessed by the fifth generation high-sensitive cTn assay. Multivariable generalized linear mixed models were used to evaluate the association between platelet function and cTn concentrations over time. Results Ten patients (29.4%) developed PMI. Increased P-selectin expression directly after surgery was associated with the cTn concentrations over 48 h (β = 1.39(1.1–1.75), P = 0.0064). No association was found between P-selectin measured later (at 24 h or 48 h) after surgery and cTn concentrations. Furthermore, there was no association between the explorative coagulation parameters and cTn release. Conclusion Increased P-selectin expression measured directly after surgery is associated with elevated cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery.
Oral Presentation No. 114 Small-bore aspiration thrombectomy versus catheter-directed thrombolysis in intermediate-high risk acute Pulmonary Embolism
Authors: Mariana Martinho, Rita Calé, Ana Rita Pereira, Filipa Ferreira, Sofia Alegria, Gonçalo Morgado, Cristina Martins, Melanie Ferreira, Ana Gomes, Tiago Judas, Filipe Gonzalez, Corinna Lohmann, Débora Repolho, Pedro Santos, Ernesto Pereira, Maria José Loureiro, Hélder Pereira
Journal: Cardiovascular Research (2022)

Abstract Introduction Catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT) are treatment options in intermediate-high risk pulmonary embolism (IHRPE). Purpose Compare the efficacy and safety of CDT and MT in IHRPE. Methods Retrospective single-centre study of consecutive IHRPE patients (pts) since 2018, treated with CDT (5Fr Cragg-McNamara device) or MT (Indigo MT system, Penumbra 8Fr). Clinical success at 48h was defined as survival and haemodynamic (HD) stabilization, oxygenation improvement or decrease in pulmonary hypertension (PH)/right heart strain. MACE during follow-up (FUP) was a composite endpoint of cardiovascular mortality, PE recurrence, chronic thromboembolic PH and heart failure hospitalization. Safety endpoint was defined as Major bleeding (BARC3). Results Of 25 pts, 60% were submitted to MT and 40% to CDT. Age (68.6 ± 15.6 vs. 62.7 ± 16.4, P = 0.381), Charlson Comorbidity Index (4.2 ± 1.9 vs. 2.9 ± 2.0, P = 0.121) and PESI score (103.2 ± 40.6 vs. 119.8 ± 46.2, P = 0.410) were similar. MT had increased fluoroscopy time (43.0 ± 19.1 vs. 10.1 ± 6.2 min, P &amp;lt; 0.001) and procedure time (115 ± 63 vs. 45 ± 18 min, P = 0.009). Success at 48 h was similar (80% MT vs. 90% CDT; P = 0.626). Severe adverse events related with the technique happened in 2 pts in MT (1 death, 1 macroembolization) and 1pt in CDT developed HD instability. Haemoglobin fall was higher in MT (1.8 ± 1.3 vs. 0.7 ± 0.8 g/dL, P = 0.018), but BARC3 and transfusion were identical. In-hospital mortality was 8% (2 pts in MT, P = 0.229). Mean FUP was 229 ± 147days, with higher MACE in MT (40% vs. 0%, P = 0.051). Conclusions Despite similar efficacy at short-term, adverse events related to the procedure seemed higher in MT group. CDT was less time consuming.
Oral Presentation No. 093 Assessing different noncoding RNAs as markers of platelet reactivity
Authors: Clemens Gutmann, Temo Barwari, Christian Schulte, Bhawana Singh, Konstantinos Theofilatos, Abhishek Joshi, Anna Zampetaki, Melissa V Chan, Paul C Armstrong, Stefan Kiechl, Johann Willeit, Timothy D Warner, Manuel Mayr
Journal: Cardiovascular Research (2022)

Abstract Background Antiplatelet therapy (APT) has improved cardiovascular outcomes, but some patients develop thrombosis despite APT. Adjusting APT to platelet reactivity with conventional platelet reactivity tests has proven unsuccessful. Many circulating noncoding RNAs (ncRNAs) are derived from platelets and could serve as novel platelet function markers. Material and methods Platelet reactivity was assessed using light transmission aggregometry (LTA) in the Bruneck 2015 study (N = 338), using the agonists arachidonic acid, adenosine diphosphate, collagen, TRAP-6 amide and U46619. LTA platelet releasates were then used for RT-qPCR of five platelet-enriched microRNAs, three circular RNAs and two long non-coding RNAs. Platelet-poor plasma (PPP) was used as negative control. Results and conclusions Platelet agonists induced aggregation and ncRNA release, with aspirin takers (N = 155) showing lower ncRNA release than individuals not on aspirin (N = 183). Agonist responsiveness differed among ncRNAs, with miR-150 being hyperresponsive to adenosine diphosphate and miR-21 being hyperresponsive to arachidonic acid, whereas other ncRNAs were most strongly released to collagen, suggesting a selective release mechanism. In individuals not on aspirin, the inflammation markers C-reactive protein and granulocyte counts correlated positively with platelet-derived ncRNAs in PPP, while they correlated inversely with platelet-derived ncRNAs in releasates. These correlations were not present in aspirin takers. Higher PPP levels and lower releasate levels of platelet-derived ncRNAs in inflammation suggest platelet exhaustion ex vivo due to platelet pre-activation in vivo. Funding sources British Heart Foundation, VASCage (Centre for Promoting Vascular Health in the Ageing Community) of the Austrian Research Promotion Agency FFG (COMET program - Competence Centers for Excellent Technologies).
Oral Presentation No. 53 Dose-related preprocedural patency of the infarct-related artery after zalunfiban (RUC-4) administration upon arrival at the catheterization laboratory in ST-elevation myocardial infarction: insights from the phase IIa study
Authors: Sem A O F Rikken, W L Bor, K L Zheng, C M Gibson, C B Granger, B S Coller, O Bentur, R Lobatto, S Postma, A W J Van 't Hof, J M Ten Berg
Journal: Cardiovascular Research (2022)

Abstract Background The importance of time to reperfusion after ST-elevation myocardial infarction (STEMI) is well established. Pre-hospital use of glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors improves pre-percutaneous coronary intervention (PCI) perfusion rates, but they require intravenous administration and continuous infusions and so are difficult for ambulance services to administer. Zalunfiban (RUC-4) is a novel, subcutaneously administered, GPIIb/IIIa inhibitor specifically developed to facilitate pre-hospital administration, thereby maximizing the chance for early reperfusion. This sub-analysis investigated the incidence of complete reperfusion (TIMI grade 3 flow) before primary PCI in patients treated with zalunfiban on arrival at the catheterization laboratory as a function of the dose of zalunfiban. Material and methods This was a prospective, single-centre, open-label, phase IIa study designed to assess the pharmacodynamics, pharmacokinetics, and tolerability of zalunfiban in patients with STEMI undergoing primary PCI. Zalunfiban was administered immediately upon arrival at the catheterization lab, which was ∼10–15 minutes before the initial angiogram used to assess TIMI grade flow. Results and conclusion A total of 27 patients received a weight-adjusted subcutaneous injection of zalunfiban in escalating doses (0.075 mg/kg [n = 8], 0.090 mg/kg [n = 9], or 0.110 mg/kg [n = 10]). Of these, 25 patients were evaluable for angiographic analysis. TIMI flow grade 3 pre-PCI was observed in 1/7, 2/9 and 5/9 patients and showed a dose-related effect (Ptrend = 0.04). The ongoing international, phase III, double-blinded, randomized, placebo-controlled, CELEBRATE trial is designed to assess whether a single, ambulance-based pre-hospital injection of zalunfiban results in improved clinical outcome. Funding This study was supported by CeleCor Therapeutics.
Poster No. 128 Association of platelet markers with occurrence of thromboembolic and bleeding events following left atrial appendage occlusion
Authors: Errol Aarnink, Domenico G Della Rocca, Pedro L Cepas, Amin Polzin, Luca Branca, Daniel Spoon, Xavier Freixa, Lucas V A Boersma
Journal: Cardiovascular Research (2022)

Abstract Background Patients undergoing left atrial appendage occlusion (LAAO) often are at increased risk for bleeding or thromboembolic events. In most implanting centers, baseline blood is drawn as a pre-procedural check-up. However, it is unknown what laboratory parameters have added value in this specific population. Platelet count (PLC) and mean platelet volume (MPV) may identify which patients are at risk for thromboembolic events or bleeding. Materials and methods Five implanting centers retrospectively gathered data on pre-procedural platelet markers. Composite endpoints on thromboembolic events (stroke, transient ischemic attack, device-related thrombus and systemic embolism) and bleeding (minor, major, and intracranial hemorrhage) were collected. Results and conclusions A total of 1138 patients were included (73 ± 8 years, 63% male, CHA2DS2-VASc: 4.4 ± 1.5; HAS-BLED: 3.2 ± 1.1). Implanted devices consisted of Watchman 2.5/FLX (n = 778), Amplatzer Cardiac Plug/AMULET (n = 315), or another device (n = 45). Baseline PLC was present in 91% and MPV in 41%. PLC was significantly lower in the 97 patients developing a thromboembolic event (206 ± 73 vs. 225 ± 72*10*9/L, P = 0.028), but no difference in MPV was observed (9.7 ± 1.4 vs. 9.5 ± 1.5 fL, P = 0.40). In another 97 patients, significant bleeding was observed during follow-up. No difference in baseline PLC was found (216 ± 79 vs. 207 ± 72*10^9/L, P = 0.30) and a trend towards lower MPV could be observed (9.5 ± 1.3 vs. 9.8 ± 1.5 fL, P = 0.07). Patients developing bleeding more often were discharged with antiplatelet therapy, while patients developing a thromboembolic event more often received anticoagulation therapy. In conclusion, occurrence of a thromboembolic event was associated with lower baseline PLC, which may be explained by PLC being lower in more frail patients.
Oral Presentation No. 121 Aortic stiffness descriptors by cardiac magnetic resonance are correlated with mechanical testing of ex-vivo aortic aneurysms specimens
Authors: Aroa Ruiz Muñoz, Andrea Guala, Myriam Cilla, Miguel Martínez, Lydia Dux-Santoy, Gisela Teixidó-Turà, Juan Garrido-Oliver, Laura Galian, Augusto Sao-Aviles, Arturo Evangelista, Ignacio Ferreira-Gonzalez, Estefania Peña, Jose Rodriguez-Palomares
Journal: Cardiovascular Research (2022)

Abstract Background Aortic stiffness independently predicts mayor adverse cardiovascular events and mortality in the general population. Cardiovascular magnetic resonance (CMR) permits the assessment of a number of parameters theoretically linked to aortic stiffness, such as distensibility (AD), pulse wave velocity (PWV) and proximal aorta longitudinal strain. However, no previous study validates these parameters as descriptors of aortic wall stiffness against ex-vivo mechanical testing. Materials and methods Ascending aorta (AAo) specimens were collected from 20 patients undergoing AAo replacement for aneurysms. Patients underwent a CMR protocol in the days leading to the surgery, including 4D flow CMR. Two 15×5 mm specimens (one oriented in the circumferential and the other in the longitudinal aortic direction) were extracted during surgery, and later tested controlling for extension force. Elongation was measured by laser video extensometer and the tangent of the stress-strain curve at diastolic pressure was extracted. AAo PWV and the Eh product (E being Young modulus and h wall thickness) were measured from 4D flow CMR while AD and AAo longitudinal were quantified from cine images. Results and conclusions Marked correlations were found between circumferential elastic modulus and AAo AD (R = −0.502), PWV(R = 0.652) and Eh (R = 0.602). Similarly, strong correlation was identified between AAo longitudinal strain and longitudinal elastic modulus(R = −0.513). In conclusion, PWV and the Eh product are positively related to aortic wall stiffness while aortic distensibility and strain show negative relationships. Thus, these biomarkers are a reliable expression of aortic wall stiffness. Funding PI17/00381,SEC/FEC-INV-CLI20/015,LCF/BQ/PR22/11920008.
Poster No. 104 Impact of pre-treatment with a P2Y12 receptor inhibitor on delay to CABG surgery in a real-world population with non-ST segment elevation acute coronary syndrome
Authors: Daniel Gomes, Bruno M L Rocha, Jorge Ferreira, Mariana Sousa Paiva, Rita Reis Santos, Marina Raquel Santos, Gonçalo Cunha, Pedro de Araújo Gonçalves, Susana Fevereiro, Marisa Trabulo, Carlos Aguiar, Miguel Sousa-Uva, José Neves, Miguel Mendes
Journal: Cardiovascular Research (2022)

Abstract Background ESC guidelines for non-ST elevation acute coronary syndromes (NSTE-ACS) recommend against P2Y12 pre-treatment receptor inhibitors (P2Y12i) in patients undergoing early invasive management (&amp;lt; 24 h). The rationale is, in part, to prevent bleeding complications and the delay of coronary artery bypass graft surgery (CABG) in patients with suitable anatomy. This study aims to analyze the impact of P2Y12i pre-treatment on delay to CABG surgery in a real-world population with NSTE-ACS. Methods Single-centre retrospective cohort of consecutive patients with NSTE-ACS undergoing invasive evaluation in 2019. Those with previous CABG (n = 31) or non-obstructive coronary disease (n = 57) were excluded. Results Total cohort included 262 patients (mean age 68 ± 12 years, 69% male, 15% with unstable angina and mean GRACE score 134 ± 35). Median time from first medical contact to angiography was 2 (1–4) days. Overall, 168 (64%) patients underwent percutaneous coronary intervention, 47 (18%) were proposed for CABG and the remainder received conservative management. All patients considered for CABG received pre-treatment with P2Y12i, either clopidogrel or ticagrelor. Median time from angiography to CABG was 12 (7–15) days. Six patients experienced recurrent angina (13%) and 2 (4%) died before surgery due to refractory ventricular fibrillation. Those who underwent CABG under P2Y12i effect were more likely to receive blood and platelets transfusions (64.7% vs. 28.6%, P = 0.017 and 82.4% vs. 21.4%, P &amp;lt; 0.001, respectively), although there were no differences regarding major bleeding. Conclusion Pre-treatment with P2Y12i was a potential driver of CABG delay in our cohort. In the real-world, adopting the new recommendations of withholding pre-treatment might decrease this delay.